Obamacare is set to get more expensive for most Pennsylvanians who rely on it.<\/p>\n
Monthly premiums could rise by 300% for some residents who use the state\u2019s Affordable Care Act health insurance exchange, Pennie, to secure coverage. The average enrollee faces a possible 82% increase.<\/p>\n
All told, about 450,000 of Pennie\u2019s record 500,000 users are staring down pricier premiums.<\/p>\n
Pennie expects the increases to drive away about 150,000 of those people.<\/p>\n
\u201cThere\u2019s going to be that sticker shock, and some people will have walked,\u201d said Pennie\u2019s executive director, Devon Trolley.<\/p>\n
That is, if Congress allows the enhanced premium tax credit, a Biden-era expansion of existing subsidies for Obamacare, to expire at year\u2019s end.<\/p>\n
Pennie, insurers and health care access advocates are acutely aware the clock is ticking.<\/p>\n
Some among them view the upcoming federal funding bill, due at the end of September, as the only realistic shot of preserving the more robust subsidy.<\/p>\n
\u201cWe really see that as the last date to extend these in order to keep affordable coverage in place because open enrollment starts Nov. 1,\u201d Trolley said.<\/p>\n
A warning<\/p>\n
With an extension uncertain, Pennie began warning consumers who could lose part or all of their subsidy in a series of letters last month.<\/p>\n
Republican lawmakers are divided on the issue, even as a June poll from health policy nonprofit KFF shows 77% of the public wants the enhanced credit to stay.<\/p>\n
U.S. Rep. Brian Fitzpatrick, R-Bucks County, and others in his party have shown support for an extension.<\/p>\n
Some Republicans in Congress
\n have bristled at the price. Another decade of the program would cost $383 billion, according to the nonpartisan Congressional Budget Office.<\/p>\n
U.S. Rep. John Joyce, R-Altoona, who is Pennsylvania\u2019s only representative on the House subcommittee on health, did not respond to a request for comment.<\/p>\n
The split could set the stage for cooperation with Democrats, who widely support an extension.<\/p>\n
Shana Jalbert, director of communications and development for the Pennsylvania Health Access Network, isn\u2019t holding her breath.<\/p>\n
\u201cI don\u2019t think we\u2019re incredibly optimistic that Congress is going to renew this,\u201d Jalbert said.<\/p>\n
The costs of letting it expire would exceed any savings, according to Trolley. When people can\u2019t afford health insurance, she said, they\u2019re more likely to delay seeing a doctor until they need more serious \u2014 and costly \u2014 care.<\/p>\n
\u201cWe\u2019re not saving anything here,\u201d Trolley said. \u201cThe costs are actually higher the longer people wait to treat conditions.\u201d<\/p>\n
How does the credit work?<\/p>\n
The enhanced premium tax credit was established in the 2021 American Rescue Plan act to help more people purchase health insurance and access care during the pandemic. The Inflation Reduction Act of 2022 extended the program through 2025.<\/p>\n
It built off a subsidy baked into the 2010 Affordable Care Act, which eased the cost of coverage for anyone making between roughly $15,000 and $60,000 a year. Eligible applicants can use the credit to lower premiums up front or claim the tax break when filing their return.<\/p>\n
The enhanced version raised subsidies within that income range. For anyone making more than that, their premiums were capped at 8.5% of their earnings.<\/p>\n
More generous financial assistance has driven Obamacare enrollment to record numbers, both in Pennsylvania, with its 500,000 enrollees, and among the 24 million who used the Affordable Care Act marketplace in 2024.<\/p>\n
The enhanced credit also has allowed more consumers to purchase better health plans. The marketplace divides plans into four categories: bronze, silver, gold and platinum. Cheaper plans offer lower premiums but higher deductibles, and vice versa for more expensive ones.<\/p>\n
Since 2021, Pennie has seen more people shift from bronze to silver or silver to gold, according to Trolley. Platinum plans were only recently introduced to Pennsylvania\u2019s exchange.<\/p>\n
To obtain subsidies, consumers have to submit proof of income to their state\u2019s health insurance exchange.<\/p>\n
The exchanges are available only to people who are in the country lawfully and whose other insurance options are considered unaffordable or inadequate. Medicare and Medicaid recipients are not eligible.<\/p>\n
The spending bill signed by President Donald Trump in July will force Obamacare beneficiaries to update their income information, immigration status and other details every year or risk losing coverage. It will also shorten open enrollment by a month.<\/p>\n
What if the credit isn\u2019t extended?<\/p>\n
Nearly all Pennie users would be impacted by the credit reverting to its lesser form, Trolley said.<\/p>\n
About 10%, or 50,000, would lose the credit entirely. And 80%, or 400,000, would see their credit reduced.<\/p>\n